Healthcare Provider Details

I. General information

NPI: 1750068862
Provider Name (Legal Business Name): LS RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 MAIN ST
BRAWLEY CA
92227-2548
US

IV. Provider business mailing address

602 MAIN ST
BRAWLEY CA
92227-2548
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-3131
  • Fax: 760-344-4676
Mailing address:
  • Phone: 760-344-3131
  • Fax: 760-344-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHESHU VALMIKI
Title or Position: OWNER
Credential:
Phone: 760-344-3131